Communications Skills Dr. Alex Alexander

Course Introduction Why Communications Now?

Communication is Everything PROVE IT.

The Science Study: Acupuncture Practitioner - Patient Communication in Japan Published in: 2008 International Journal of General Medicine

Abstract We evaluated acupuncture practitioner–patient communication using pairs of practitioners and patients. Our primary objective was to evaluate the concordance of practitioner and patient perceptions in terms of explanations regarding consultation, therapy, and patient satisfaction. The subjects were 250 practitioners and their 1250 patients in Fukuoka, Japan. Answers were obtained from 91 acupuncture practitioners (36.40%) and 407 patients (32.56%). Of these, responses from 125 pairs without missing values were used for the analysis.

Abstract When practitioner–patient communication, as evaluated by the difference between the patients’ and the practitioners’ perceptions with respect to the level of practitioner explanation, was good, patient outcome (ie, satisfaction with therapy, improvement in health) was also good. Factors related to poor practitioner–patient communication included age of the practitioner, the number of practitioners at a clinic, the experience of the practitioner, and the age of the patient. These findings may be useful in improving practitioner–patient communication.

Relevance? In this study, when the relationship between acupuncture practitioner–patient communication and patient outcome was examined, the most important factor was the level of acupuncture explanation, as perceived by the patient. Reduced patient satisfaction with therapy or less improvement in health was present in those patients who did not feel communication was good.

Study #2 Title: Acupuncture Outcomes, Expectations, Patient–Provider Relationship, and the Placebo Effect: Implications for Health Promotion Published in: 2002 American Journal of Public Health

Abstract Objectives. To explore whether treatment outcomes are associated with a patient’s degree of general hopefulness, expectations regarding treatment, attributions of health status, beliefs about mind–body dualism, and patient–provider relationship factors, I studied acupuncture patients’ goal attainment.

Abstract Methods. Sixty-two acupuncture patients were interviewed before and after acupuncture regarding goal attainment, mind–body beliefs, hopefulness, and attributions of health status. Demographics, acupuncture treatment, and health care usage information was also collected. Acupuncturists provided 3 months of treatment.

Abstract Results. Patients reported treatment goal attainment from acupuncture. Their perceived outcomes were not associated with previous treatment, patient demographics, or the expected and actual numbers of needle insertion. Successful outcomes were related positively to number of different CAM treatments used in the past year but negatively to patients’ expectations and the "Powerful Others" health locus of control dimension.

Abstract Conclusions. Perceived acupuncture outcomes seem not to be related to placebo effects and patient expectations, but rather to client– practitioner relationship factors. Healt2002;92:1662–1667)

Relevance? A patient’s expectations from acupuncture treatment and "Powerful Others" health locus of control level are predictors of his or her Goal Attainment Score

Where Did Expectations Come From? The negative relationship between treatment expectation and perceived outcome and the relative salience of the "Powerful Others" health locus of control dimension should draw our attention to the client–practitioner relationship as well as factors such as trust, interpersonal style, rapport, and self-care. Better ways of measuring client–practitioner relationship and rapport are needed.

Communications in General Recent research on what makes therapy effective suggests that the style of therapy you use is not a major factor. It seems to do more with the quality of the relationship between the client and the therapist and how much the client believes the therapy will help.

What Comprises Communication? Verbal-tone, pitch, inflection, volume, etc. Nonverbal-eyes, facial expressions, body language, subtle cues, etc.

Appropriate Communications Good patient communication involves recognizing and responding to the patient as a whole person. Patient communication also involves professionalism and good clinic etiquette.

From “Communicating with Patients” Get the patient encounter off to a good start Monitor your body language Practice effective listening skills Ask questions that yield information and offer support Give answers that will be understood Partner with your patient Develop cultural competency Provide motivational counseling Demonstrate empathy and compassion

Lawsuit? Poor communication can lead to missed diagnoses, patient resentment, noncompliance, and a greater chance of being sued. An often-quoted study published in the Journal of the American Medical Association in 1997 showed that the 2 factors leading to a malpractice suit are bad outcomes and poor provider-patient communication

What’s Your Worst Example? Share your horror stories of medical communications nightmares as a patient, a person witnessing the experience, a practitioner, etc.

Horrified!